HIV and the Mouth

How Does HIV Affect the Mouth?

In the early years of the HIV epidemic, dentists were often the first health professionals to notice signs of a weak immune system. These signs were infections that are normally controlled by a healthy person. When people get tested for HIV infection and get treatment, most of these infections never show up. However, many people do not get tested for HIV. They may be infected and not know it. Regular dental care is an important way they may learn they have a weak immune system.

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According to the US Health Resources and Services Administration, over one third of people with HIV will have at least one major oral health problem, and almost two thirds do not receive regular dental care.

Don't Ignore Mouth Problems!

Pain or bleeding in your mouth can be a sign of infection. It can keep you from eating normally. Severe pain makes some people skip taking their medications. Serious infections in your mouth can cause other health problems. Be sure to see a dentist or let your health care provider know if you have trouble swallowing, changes in how food tastes, or pain or other problems with your mouth or teeth.

Some dentists or their office staffers do not want to treat patients with HIV. This goes against community standards and violates the Americans with Disabilities Act. Dental health care workers know how to protect themselves from diseases carried in the blood of their patients, including HIV.

What Are the Signs of HIV in the Mouth?

Several problems with the teeth, mouth and gums can show up in people with HIV. These are discussed below.

Dry Mouth and Tooth Decay

Candidiasis (thrush)

Canker sores (apthous ulcers)

Cold sores (herpes simplex)

Gum disease (periodontitis)

Hairy leukoplakia

Kaposi's Sarcoma

Enlarged saliva glands

Shingles (herpes zoster)

Oral warts (human papillomavirus):

Dry Mouth and Tooth Decay

Many people with HIV have dry mouth. They don't make enough saliva to chew and swallow comfortably. Saliva protects teeth and gums from infection and decay.

HIV infection can cause dry mouth. So can some medications, as well as coffee, carbonated beverages, alcohol, and smoking. If you have dry mouth, take frequent drinks of water. You can talk to your health care provider about using sugar-free gum or candy, or a saliva substitute.

Candidiasis (Thrush)

See Fact Sheet 501 for more information. This infection is caused by a fungus (yeast) called Candida. It shows up as red patches on the tongue or roof of the mouth or white lumps that look like cottage cheese that can form anywhere in the mouth. Candidiasis infection can move into the throat. It can also cause painful cracks at the corners of the mouth called angular chelitis. Many anti-fungal treatments can treat thrush. However, some cases of thrush are resistant to the usual medications.

Canker Sores (Apthous Ulcers)

These are small, round sores on the inside the cheek, under the tongue, or in the back of the throat. They usually have a red edge and a gray center. The sores can be quite painful. They can be caused by stress or by certain foods such as eating too many tomatoes. Hot and spicy or acidic foods or juices make them hurt more. Some ointments, creams or rinses can help.

Cold Sores

These are caused by herpes simplex (see Fact Sheet 508), a common infection. In people with HIV, cold sores can be more severe and can keep coming back. The most common treatment is the antiviral drug acyclovir.

Gum Disease (Periodontitis or Gingivitis)

This is swelling of the gums. Sometimes painful and bloody, it can progress from gum loss to loosening and even loss of teeth. This can happen as quickly as 18 months. Dry mouth and smoking can make gum disease worse. Brush your teeth, floss, and see a dentist regularly.

Recently, gum disease has been linked to higher levels of inflammation (see Fact Sheet 484), throughout the body. This can increase the risk of heart disease and stroke.

Hairy Leukoplakia

This is an irritation that usually shows up as painless, fuzzy white patches on the side of the tongue. It can be an early sign of HIV infection.

Kaposi's Sarcoma (KS)

See Fact Sheet 511. It usually shows up as dark purple or red spots on the gums, the roof of the mouth, and the back of the tongue. It is rarely seen when people are tested early and start using antiretroviral therapy for HIV infection. It can be the first sign of HIV infection in people who have not been tested for HIV. The best treatment for oral KS in someone with HIV is effective antiretroviral therapy.

Oral Warts -- Human Papillomavirus, HPV

See Fact Sheet 510. It is a sexually transmitted disease. Some strains of HPV cause warts or cancer. HPV warts can show up in the mouth. The warts can be frozen or cut out.

The Bottom Line

Signs of HIV infection often show up in the mouth. You might know people who haven't been tested for HIV. Encourage them to pay attention to any mouth problems.

Keep your mouth healthy by brushing your teeth and flossing. Get your teeth cleaned regularly by a dental health professional. See a health or dental care provider about any serious issues.

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